Logo American Journal of Case Reports

Call: 1.631.629.4328
Mon-Fri 10 am - 2 pm EST

Contact Us

Logo American Journal of Case Reports Logo American Journal of Case Reports Logo American Journal of Case Reports

04 May 2023 : Case report  USA

[In Press] A Case of Confounding Back Pain

Unusual clinical course, Challenging differential diagnosis

Cedric A. Green1DEF, Lydia Mbatidde2E, Jehan R. Shah1EF, Mantavya Punj3E, Ramla N. Kasozi ORCID logo1AE, Jennifer R. Maynard1E

DOI: 10.12659/AJCR.939784

Am J Case Rep In Press; DOI: 10.12659/AJCR.939784  

Available online: 2023-05-04, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Acute back pain is common in primary care settings (>60% lifetime prevalence). Patients can also have associated red flag signs, such as fever, spinal tenderness, and neurologic deficits, that warrant further evaluation and investigation to optimize diagnosis and treatment.
A 70-year-old man with a history of benign prostatic hyperplasia and hypertension sought care for midthoracic back pain. He had been recently admitted to the hospital for sepsis from a urinary tract infection (UTI) caused by multidrug-resistant (MDR) Escherichia coli. Initial treatment was conservative management with physical therapy, given the lack of red flag signs on physical examination and the likelihood that his pain was musculoskeletal, resulting from immobilization during hospitalization. At follow-up, thoracic spine radiography showed no fracture or other acute abnormalities. After persistent pain, he underwent magnetic resonance imaging, which showed T7-T8 osteomyelitis and discitis with substantial paraspinal soft tissue involvement. Computed tomography-guided biopsy showed MDR E. coli, which indicated hematogenous spread from his recent UTI. Pharmacologic treatment included intravenous ertapenem for 8 weeks, with consideration for discectomy if later indicated. This case highlights the value of maintaining a broad differential diagnosis and high alert for red flag symptoms during routine office visits with a chief concern of back pain.
A high clinical suspicion for vertebral osteomyelitis must be maintained for patients with acute back pain associated with red flag signs. Detailed assessment with appropriate investigations and close follow-up is recommended to support the diagnosis and to allow timely management to prevent complications.

Keywords: Fever; Neurologic Manifestations

In Press

06 Jun 2023 : Case report  Saudi Arabia

A Classical Case of Cesarean Scar Endometriosis in a 35-Year-Old Woman Presenting with Cyclical Abdominal P...

Am J Case Rep In Press; DOI: 10.12659/AJCR.940200  

05 Jun 2023 : Case report  USA

Peri-Hilar Cystic Lymphangioma Mimicking a Biliary Cystic Lesion Causing Biliary Obstruction: A Case Report...

Am J Case Rep In Press; DOI: 10.12659/AJCR.939421  

05 Jun 2023 : Case report  Palestinian Territory, Occupied

Recurrent Bioprosthetic Valve Serratia marcescens Endocarditis in Intravenous Drug Users

Am J Case Rep In Press; DOI: 10.12659/AJCR.939292  

05 Jun 2023 : Case report  USA

Successful Treatment of Recurrent Colonic Adenocarcinoma with Metastatic Tumor Thrombus in the Superior Mes...

Am J Case Rep In Press; DOI: 10.12659/AJCR.939156  

Most Viewed Current Articles

06 Dec 2021 : Case report  Brazil

Lipedema Can Be Treated Non-Surgically: A Report of 5 Cases

DOI :10.12659/AJCR.934406

Am J Case Rep 2021; 22:e934406

13 Jul 2022 : Case report  USA

Whistling Scrotum: An Unusual Presentation of Pneumomediastinum in the Setting of an Open Scrotal Wound

DOI :10.12659/AJCR.936441

Am J Case Rep 2022; 23:e936441

07 Dec 2021 : Case report  USA

Edwardsiella tarda: A Classic Presentation of a Rare Fatal Infection, with Possible New Background Risk Fac...

DOI :10.12659/AJCR.934347

Am J Case Rep 2021; 22:e934347

23 Feb 2022 : Case report  USA

Penile Necrosis Associated with Local Intravenous Injection of Cocaine

DOI :10.12659/AJCR.935250

Am J Case Rep 2022; 23:e935250

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923